It feels like 90% of the products being hawked as treatments for learning and developmental disorders like dyslexia, language impairments, autism, Asperger’s and ADHD make claims about the brain. Claims include:

“based on brain science”.

“designed by neuroscientists”

“brain based”

“neuroplasticity”

“sharpen memory and attention with brain games and tools”

“change your brain”.

There’s a good reason why companies invoke brain science in selling products. Research has shown that consumers are more likely to rate a claim as credible if it is accompanied by a picture of a brain image (McCabe & Castel, 2008). This seems to happen even if the claim is complete nonsense. Is it any wonder that programs and products (see here, here and here for examples) invoke the brain in the marketing process? It seems human lose their powers of reasoning when presented with a brain.

The neuroscientist Molly Crockett has given a recent TED talk titled “Beware neuro-bunk” in which she cautions against placing too much stock in claims ‘based on neuroscience’.

Crockett cautions us that there’s always more to the story than the brain images. She says “if someone tries to sell you something with a brain on it, ask to see the evidence. Ask for the part of the story that’s not being told.”

May was a busy time in Australian schools with Grades 3, 5, 7 and 9 involved in the national literacy and numeracy tests (NAPLAN). The stress I see in parents and learning support colleagues during NAPLAN time often causes me to reflect on the purpose of the test(s) and how useful they are for students who have learning difficulties.

The Australian Curriculum, Assessment and Reporting Authority (ACARA) claim that the purpose of NAPLAN is to “measure the literacy and numeracy skills and knowledge that provide the critical foundation for other learning”. They also claim that introduction of NAPLAN has led to “consistency, comparability and transferability of information on students’ literacy and numeracy skills”. (Don Watson would have a field day with these weasel words).

NAPLAN is useful because it identifies students who are struggling with the broad academic skills. Having an objective measurement is important because research has shown that teachers are not particularly accurate in identifying struggling students. For example, Madelaine and Wheldall (2007) randomly selected twelve students from 33 classes and asked their teachers to rank the students based on perceptions of reading performance. They also assessed the students on a passage reading test. Only 50% of teachers identified the same poorest reader as the objective test and only 15% of teachers identified the same three lowest performing readers as the test. We can certainly argue about whether NAPLAN in its current form is the most effective and/or cost-effective method of gathering data on student achievement, however, it seems that we cannot rely on teacher judgment alone.

On the downside, NAPLAN represents a test, not an assessment. All good clinicians and educators know, there is a difference, or should be, between testing and assessment (see here and here). Assessment is a process that starts with the history and clearly defines the presenting problem or set of problems. The clinician develops an hypothesis or set of hypotheses on the basis of the history. They then gather data (e.g., observations, interviews, tests, and base rates) that is designed to shed light on the hypotheses. It is worth noting that a good clinician looks equally for data that confirms and disconfirms the initial hypotheses. Good assessment should lead directly to treatment and/or appropriate teaching for the presenting problem(s) and provide pre-treatment data that allows monitoring of progress. Testing on the other hand simply tells us how good or bad a student is on a particular test. For example, a student with a low score on a reading comprehension test can be said to have poor reading comprehension. The problem with tests is they don’t tell why a student performed poorly and, if they measure a complex process like reading comprehension, writing, or mathematical reasoning, they don’t tell what component of that complex process is weak.

That is precisely the problem with NAPLAN. The NAPLAN tasks are complex and provide little information useful for designing interventions for students with learning difficulties and for monitoring response to intervention. An example from NAPLAN illustrates this point.

A mathematics question asked: $4 is shared equally among 5 girls. How much does each girl get? An incorrect response tells us that the student can’t do the task. So what? The child’s teacher probably knew that already. What would be useful would be to know if the student failed the item because (1) they couldn’t read the question, (2) they didn’t know what ‘shared’ or ‘equally’ meant, (3) they didn’t recognise the item required a division operation, (4) they didn’t know to convert $4 to 400c to make the division easier, (5) they didn’t know the fact 40 divided by 5, (6) they knew all of the above but have attention problems and got ‘lost’ during the multi-step division process.

Similarly, if a student performs poorly on the writing component of NAPLAN no information useful for treatment is obtained. The test doesn’t tell us if the child (a) has a form of dyspraxia and struggles with handwriting, (b) has an impoverished spelling lexicon, (c) has poor knowledge of sound-to-letter conversion rules and therefore struggles to spell unfamiliar words, (d) poor knowledge of written grammatical conventions, (e) poor knowledge of written story grammar, (f) oral language weaknesses in semantics and/or grammar, (g) poor oral narrative skills, (h) attention problems so therefore s/he can’t keep his you know what together while doing a complex task, or (i) autism and therefore doesn’t give a toss about the writing topic. The list could go on.

Unfortunately, NAPLAN provides none of these specific data. It simply tells us how bad the child performs relative to some arbitrary benchmark. So where does this leave us? Or more to the point, where does it leave students who have learning difficulties?

Both of which lead me to think that NAPLAN is probably not all that useful for students who have learning difficulties or for the parents, clinicians and teachers who work with them. It also leads me to yearn even more for a Response-to-Intervention approach in which schools recognise learning problems early in the child’s school career, assess to define the problem(s), and provide evidence-based interventions that target the problem(s).

Students who have Asperger’s Syndrome can display challenging behaviour. They may be ‘runners’ or they may lash out at teachers among other things. They usually do so because they are experiencing some form of emotional distress as a result of excessive/unpleasant sensory stimulation, because they have difficulty understanding other people’s perspectives, because they have difficulty coping with change, or because they have an otherwise inflexible behavioural repetoire, amongst other things.

A patient (male, 10 years of age) who we will call Jack (isn’t every second boy called Jack?) has been ‘running’ or punching/hitting/biting others, including teachers, when he is distressed. Jack’s support teacher has indicated to his mother that his behaviour is unpredictable and that therefore they are having difficulty managing him. In other words, they are finding it hard to identify the antecedents of his behaviour. Identifying antecedents is a good thing to do and changing them is very effective. For example, a child who becomes anxious about not knowing what to do when he first arrives in the classroom each morning (i.e., he doesn’t have a routine) can be assisted by getting him to class early and giving him a job (e.g., he can be book monitor or fish feeder etc). However, antecedents can be hard to find and it is not always possible to change them even if one is aware of them. Changing the behaviour of children who have Asperger’s therefore often requires a different type of behaviour therapy. Before we look at what that might be let’s quickly revisit B.F. Skinner’s laws of the universe.

Positive reinforcement. When a behaviour is followed by a rewarding stimulus the likelihood of the behaviour occurring again is increased.

Negative reinforcement. When a behaviour is successful in eliminating or reducing a distressing stimulus it is rewarded and the likelihood of the behaviour occurring again is increased.

Punishment. When a behaviour is followed by a punishment the likelihood of the behaviour occurring again is decreased.

Shaping. Human behaviour rarely changes immediately, just as young canines do not learn to walk without a leash on their first day of obedience training. Shaping is a conditioning procedure in which successive approximations of a behaviour are reinforced. Successive approximations refer to increasingly accurate representations of the behaviour desired by the teacher. The principles of shaping can be illustrated in the training of a puppy. If one desires the puppy to sit and stay while you are out of sight, one doesn’t sit the puppy down and walk around the corner. Rather one teaches it to stay while you are beside it and have it on a tight leash. A reward is provided after it stays for the briefest of moments. The period for which it must stay and the distance between the puppy and owner is increased with rewards provided for successful performance at each increment until, finally, it is able to perform the desired behaviour.

Positive reinforcement is more effective at changing behaviour than punishment.

Behaviour management methods are neither right nor wrong; they’re just effective and ineffective.

Getting back to Jack; like many kids who have Asperger’s, he lacks the ‘software’ that allows him to make sense of his social world. He needs the adults around him to provide him with software ‘plug-ins’. How can we accomplish this? By using Skinner’s laws of positive reinforcement and shaping.

Jack is clearly trying to avoid distressing situations. That he continues to do so shows that the punishment being used by the school is not working and that his current behaviour, while maladaptive, is having a negatively reinforcing effect. A more effective method must be found.

The new approach can begin by writing a Social Story that describes for Jack how he might respond in a particular situation. This might include suggesting to Jack that when he begins to feel distressed in the classroom he is to (a) go to his teacher and ask for his iPod, (b) move to his quiet time area, (c) stay in his quiet time area until he feels like he can manage himself back in the class, (d) return to the class and discuss a solution to the problem with his teacher. Parents and the school then need to identify an external reward that may serve as positive reinforcement. Next, the teacher has to shape Jack’s behaviour by paying attention to him and trying to catch him doing something that resembles the terminal goal of following the ‘calm down’ procedure described above. When she catches him he should receive the stimulus we hope will be positively reinforcing.

A new shaping procedure begins once Jack is able to perform the terminal behaviour. At this point the teacher begins to fade the Social Story by requiring him to perform successively more difficult versions of the Social Story until he can eventually solve the problem/distress by simply leaving his seat and discussing a solution with his teacher.

Finally, learning doesn’t occur when the child is in distress. Teachers and parents are often so relieved when the child behaves appropriately that they forget to catch them being good and provide reinforcement. The trick to successfully teaching an kid with Asperger’s how to behave is to use these “good” times as teaching moments. Grab them (not literally for those readers who may have Asperger’s themselves:) and talk about the behaviours they used that were successful. Discuss why they might have been successful and how they might be used in the future. Refer back to them before future events and discuss whether the previously successful behaviour might be worth another shot. If it works, debrief again. Eventually, if a behaviour works often enough it can become a rule and we all know that Aspies love rules.

The autism spectrum includes a number of conditions including Autistic Disorder and Asperger’s. In this post I will use the term autism.

There seems to be controversy about whether autism is a disorder of development and therefore represents a bunch of abnormal characteristics or whether it is a separate cognitive phenotype that represents a different way of communicating and interacting with the world. It may be that autism researchers still need to answer this question. However, as a clinician I prefer the latter concept because it allows autism to be “sold” much more positively. Michelle Dawson’s blog provides good examples of a positive world view of autism.

This blog aims to provide a brief summary of some of the cognitive characteristics that are common in autism. It is by no means an exhaustive list. I have selected some of those things I have seen in autists that are most relevant for the education content.

Theory of Mind

Autists are described as having poor “theory of mind”. Essentially, this means that they have difficulty understanding other peoples’ perspectives or “getting inside their heads”. Another way of putting it that seems to appeal to some individuals with autism is that they lack “social recognition software”. They lack the ability to recognise social situations and what is going on in those situations, what the appropriate responses to people might be, and the awareness of why people respond to their behaviour in certain ways.

As a consequence, individuals with autism or those with milder characteristics may not respond as well to praise or punishment in the classroom. Those with learning difficulties often detest being asked to repeat things, particularly in intervention-type programmes. Rather than recognising that the teacher may be asking them to ‘try again’ because it will help them learn, the child with autism may consider the teacher’s motives to be more sinister (i.e., “She thinks I’m dumb” or “She’s a mean person”). Equally, educators can sometimes be shocked or upset when the child with autism does not respond as expected to praise. For example, after finding out that the child has worked hard over a fortnight and can now do long division, we might get a bit excited and expect the child to look and sound proud and happy. Sometimes though, the child will look at the adult as if they are stupid or even with disgust. You might imagine that they are thinking, “Of course I can do it. Do you think I’m stupid?”

Cognitive Inflexibility

Some people have difficulty being flexible and creative in their thinking. They tend to develop one method of doing things and they stick to it even when it doesn’t always result in success. Note that the existence of cognitive inflexibility in autism is controversial.

Fact vs. Fiction

Many individuals with autism are oriented towards fact rather than fiction. They may not see the point in reading about or discussing fictitious material. This inclination can have positives and negatives in the classroom.

Specialist vs. Generalist

There are some people in the world who are what we call generalists. They are reasonably good at most things and take a broad interest in the world. Other people, including many individuals with autism, are more specialised in their orientation. Both are valid: can you imagine a world without Van Gogh, Hans Christian Anderson, or Bill Gates? All are people who have developed a specialty or have been consumed by a particular area of interest.

The trick in the classroom is that it is a place built for generalists. The specialist is disadvantaged until they can leave school and focus attention on their specialty.

Concept vs. Detail

Conceptual development is an important part of social and academic learning. Concepts help us cut through detail and to focus on the big picture. They also help as a way of subsuming a whole bunch of details under a single idea. In both ways, concepts facilitate problem solving. For example, many of us have some kind of social concept that describes the key elements of a social interaction. Subsumed under that concept are examples of social interactions (e.g., good and bad) and the elements that are characteristic of each (e.g., smiling, eye contact, asking questions vs. creeping away from you, scowl on face). This system allows us to focus on the overall interaction rather than the detail, while at the same time allowing us to recognise when something is awry and how we may go about resolving that problem.

Other people find it hard to learn concepts. These people might be described as not being able to “see the trees for the wood”. They focus on detail at the expense of the big picture. They tend to learn detail without understanding how the details are related (i.e., part of a concept). They may also dogmatically apply a rule or concept to situations incorrectly because they don’t truly understand the rule. That is, it affects their reasoning.

For example, Teddy is a 6-year old who has been taught that the sun can burn you and that we should wear a hat and sunscreen when we go outside. He now gets distressed every time he goes outside without sun protection because he might “burn up” – this even if he is to be outside for the briefest of times. Teddy has also covered his west-facing window because he thought it was going to be burned by the afternoon sun.

David is a twelve-year old who has a special interest in zoology. He can talk for hours about wolves; what they look like, what they eat, and unusually, their social habits, and their motives for social behaviour. However, he has little knowledge of how wolves and their social behaviour share similarities to humans; nor in fact does he care much. David will probably be a good candidate for a PhD in zoology on pack animals but may find it more difficult to cope with the generalist demands of High School biology.

Literal vs. Figurative

Individuals with autism interpret language literally. They can have great difficulty with figurative language (e.g., “he was as red as a beetroot”; “the grass was singed to the colour of gold”) and with drawing inferences when reading or listening. Hence, they are oriented towards factual texts that inevitably contain little ‘flowery’ language or need to develop sophisticated inferences.